title: Simplified validated prognostic model for progression-free survival after autologous transplantation for hodgkin lymphoma.
abstract: Hodgkin lymphoma (HL) prognostic models based on factors measured at time of autologous hematopoietic cell transplantation (AHCT) are limited by small sample sizes. Models based on information at diagnosis are often not uniformly collected or available at transplantation. We propose an easily implementable prognostic model for progression-free survival (PFS) post-AHCT based on factors available at transplantation in a large international cohort of HL patients. The outcomes of 728 AHCT recipients for relapsed/refractory HL were studied. Patients were randomly selected for model development (n = 337) and validation (n = 391). The multivariate model identified 4 major adverse risk factors at the time of AHCT with the following relative weights: Karnofsky performance score <90 and chemotherapy resistance at AHCT were each assigned 1 point, whereas at least 3 chemotherapy regimens pre-AHCT and extranodal disease at AHCT were each assigned 2 points. Based on the total score summed for the 4 adverse risk factors, 3 risk groups were identified: low (score = 0), intermediate (score = 1 to 3), or high (score = 4 to 6). The 4-year PFS for the low- (n = 176), intermediate- (n = 261), and high- (n = 283) risk groups were 71% (95% confidence interval [CI], 63% to 78%), 60% (95% CI, 53% to 66%), and 42% (95% CI, 36% to 49%), respectively. The prognostic model was validated in an independent cohort. The Center for International Blood and Marrow Transplant Research model is based on factors easily available at the time of AHCT and discriminates patients with favorable post-AHCT outcomes as well as an intermediate-risk group. This model should assist in the prospective evaluation of alternative treatment strategies.
authors.affiliation: Division of Blood and Marrow Transplant, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Ginna G
authors.initials: GG
authors.lastname: Laport
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hodgkin lymphoma; Prognosis